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18 Dental Tribune Middle East & Africa Edition | March-April 2015ortho tribune Joint Meetings with AAID 4th Global Conference ‘ 11 - 15 November 2015 Jumeirah Beach Hotel Dubai, UAE Inman Aligner Symposium www.cappmea.com/aesthetic2015 Clear fixed appliances chosen over aligner treatment for arch development By Dr. Stuart Frost, USA P retreatment Diagnosis Class I (end-to-end molar on right), female patient, 38, presented for clear aligner treatment. She had had ortho- dontic treatment years before. Given that her chief concerns were the crowding in her lower arch and widening her smile, I was able to convince her that passive self-ligation would offer her the results she wanted and could satisfy her need for esthet- ics since Damon Clear was then available in prototype. She had no jaw popping or clicking. Facial/Soft Tissue/Macroes- thetics: Mildly convex profi le and nasolabial angle. Slight lip strain at rest with lower midline shifted to the right. Smile/Miniesthetics: Excessive upper gingival display, narrow arches with 3 to 4 mm of crowd- ing in the lower arch and 1 to 2 mm of crowding in the upper arch. Consonant smile arc. Teeth/Microesthetics: Estheti- cally-shaped teeth and excellent hygiene. Inconsistent gingival architecture in the lower anteri- ors and UR3. TreatmentObjectivesandPlan Treat nonextraction, eliminating the crowding by widening the arches, using the Damon Clear prototype brackets U3-3 and Da- mon Q (DQ) elsewhere. Employ variable torque and bracket po- sitioning to maintain the smile arc. Damon Clear/DQ Variable Torques Employed U1s: Standard torque (+15) U2s: Standard torque (+6°) U3s: Standard torque (+7°) L1-2s: Low torque (-11°) LL3: Super torque (+13°) LR3: Standard torque (+7°) Treatment Sequence Bonding U/L: Direct-bonded U/L arches, engaging.014roundDamonOp- timal Force Copper Ni-Ti1 (Cu Ni-Ti) archwires. After 4 weeks, transitioned into .014 x .025 (up- per) and .018 round (lower) Cu Ni-Ti archwires. Started shorty CL II elastics (bilaterally L6 to U4, full time with Quail, 3/16”, 2 oz.), maintaining them through- out treatment. 2 Months: Shorty CL II Elastics Maintained Throughout Treatment U: Transitioned into .018 x .025 Cu Ni-Ti archwires. L: Transi- tioned to .014 x .025 Cu Ni-Ti archwires. 3-5 Months: Bracket Reposi- tioning U: Repositioned the UR3 and dropped the wire size to a .014 x .025 for 6 weeks before transi- tioning back to a .018 x .025 di- mension. L: Maintained the .014 x .025 Cu Ni-Ti archwire over this period. 5.5Months:InterimPanograph U/L: Maintained the same arch- wires. Took interim panograph and repositioned UR4, LR1 and LR3. The repositionings were minor so did not have to reduce the wire dimensions. 6.5 Months: Torquing & Step- Up Bends in TMA U: Transitioned to a .019 x .025 TMA archwire, adding 10° of buccal crown torque to the UL3. L: Transitioned to a .017 x .025 TMA archwire with a step-up bend in the LR4. Maintained these archwires until debond- ing. 8.2 Months/7 Treatment Ap- pointments: Treatment Com- plete We achieved all treatment and patient objectives. Widening the transverse arch width, espe- cially U2-2, also diminished the excess gingival display. While the patient had originally inquired about clear aligner treatment, the fee would have been substantially more and would not have allowed us to meet one of her chief objectives, which was transverse arch de- velopment. While clear aligner treatment can satisfy certain needs, esthetic fi xed appliance treatment allows us to achieve outstanding results. Pretreatment Diagnosis Treatment Completed Pretreatment 8.2 Months/7 Treatment Appoint- ments: Treatment Complete 2 Months: Shorty CL II Elastics Maintained Throughout Treatment 6.5 Months: Torquing & Step-Up Bends in TMA What I Would Do Differently Today The patient had a lateral tongue thrust at the UR3. Were I to treat the case today, I would place lingual tongue reminders on the LR3 that would likely have resulted in a more satisfactory Class I right cuspid relationship. References 1. All Copper Ni-Ti wire used is Damon Optimal Force Copper Ni-Ti. Contact details available from the publisher